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Bair-Merritt, M. H., Jennings, J. M., Chen, R., Burrell, L., McFarlane, E., Fuddy, L., et al. (2010). Reducing maternal intimate partner violence after the birth of a child: A randomized controlled trial of the Hawaii Healthy Start home visitation program. Archives of Pediatrics and Adolescent Medicine, 164(1), 16–23.

Model(s) Reviewed: Healthy Families America (HFA)®
Manuscript screening details
Screening decision Screening conclusion
Passes screens Eligible for review
Study design details
Rating Design Attrition Baseline equivalence Reassignment Confounding factors
High Randomized controlled trial Low Established on race and feasible outcome measures but not on SES (i.e., mother’s employment). Maternal employment is included as a control. None None
Notes:

footnote79

Submitted by user on Fri, 03/15/2019 - 14:29

High rating applies to overall maternal <abbr title="Intimate partner violence">IPV</abbr> victimization and perpetration outcomes only. Outcomes pertaining to specific types of maternal <abbr title="Intimate partner violence">IPV</abbr> victimization and perpetration receive a low rating because the analyses do not control for baseline outcome measures.

Study characteristics
Study participants Families were recruited to the study between November 1994 and December 1995. Hawaii Healthy Start Program staff screened the medical records of mothers from one of four Oahu communities delivering children at Kapiolani Maternity Hospital for risk factors for child abuse and neglect. Mothers found to be at risk, or those whose records did not contain sufficient information to screen out, were screened further using the Kempe Family Stress Checklist; eligible families were those in which either parent scored 25 or greater. Of the 897 families who were eligible to participate in the study, 730 (81%) agreed to participate and were randomly assigned to the program group (n = 395), the main comparison group (n = 290), or a testing comparison group (n = 45). This study includes data from all three follow-up years of the Hawaii Healthy Start randomized controlled trial. Specifically, the sample includes 373 families from the program group and 270 families from the main comparison group. At baseline, 24% of program group and 21% of comparison group mothers were age 18 or younger, 45% of program group and 48% of comparison group mothers were between the ages of 19 and 25, and 31% of mothers in both groups were age 26 or older. 64% of program group mothers and 69% of comparison group mothers were high school graduates. The racial composition of the program group was 34% native Hawaiian or Pacific Islander, 28% Asian or Filipino, 10% Caucasian, and 28% of unknown primary ethnicity. The comparison group consisted of 33% native Hawaiian or Pacific Islander, 28% Asian or Filipino, 13% Caucasian, and 26% of unknown primary ethnicity.
Setting Six Healthy Start Program sites operated by three community-based organizations in Oahu, Hawaii.
Intervention services Home visiting services were designed to provide three to five years of home visiting, with weekly visits for most or all of the child’s first year of life, and visits of gradually decreasing frequency thereafter depending on family need. Home visitors endeavored to establish trusting relationships with families, help them resolve immediate crises, and help them build on existing strengths to improve their ability to function independently. Visitors helped families develop problem-solving skills, connected them to needed services, and aimed to develop an individual service plan with each family every six months and help the family reach six-month goals. The actual frequency of visits, however, was lower than that specified by the model, with families receiving an average of 13 visits in the child’s first year of life (Duggan et al., 1999). Family participation rates declined over time, with 90% participating when the child was 3 months of age, 70% at 6 months, 49% at 12 months, and 25% when the child was 36 months old.
Comparison conditions The main comparison group was tested annually to measure outcomes. A second “testing” comparison group was evaluated only at year 3 to ascertain the effect of repeated testing on observed outcomes (Duggan, McFarlane, Fuddy, Burrell, Higman, Windham, et al., 2004).
Staff characteristics and training Trained paraprofessionals were recruited from the community to conduct the home visits.
Funding sources The parent study, evaluation of the Hawaii Healthy Start Program, was supported by grants R40 MC 00029 and R40 MC 00123 from the Federal Maternal and Child Health Bureau; the Robert Wood Johnson Foundation; the Annie E. Casey Foundation; the David and Lucile Packard Foundation; the Hawaii State Department of Health; and grant P30MH38725 from the National Institutes of Health. Dr. Bair-Merritt is funded in part by Career Development Award K23HD057180 sponsored by the National Institute of Child Health and Human Development.
Author affiliation None of the study authors are developers of this model.

Findings details

Reductions in juvenile delinquency, family violence, and crime
Rating Outcome measure Effect Sample Timing of follow-up Sample size Intervention group Comparison group Group difference Effect size Statistical significance Notes
High Maternal perpetration (CTS)
FavorableUnfavorable or ambiguousNo Effect
Full sample, Hawaii trial Average across 3 years of program 640 mothers Mean = 5.08 Mean = 7.72 IRR = 0.83 Not available Statistically significant,
p < 0.05

footnote60

Submitted by user on Fri, 03/15/2019 - 14:29

Actual p-value was not reported by the authors.

High Maternal perpetration (CTS)
FavorableUnfavorable or ambiguousNo Effect
Full sample, Hawaii trial Average when child was 7-9 years old 640 mothers Mean = 2.45 Mean = 2.51 IRR = 0.98 Not available Not statistically significant, p ≥ 0.05
High Maternal victimization (CTS)
FavorableUnfavorable or ambiguousNo Effect
Full sample, Hawaii trial Average across 3 years of program 640 mothers Mean = 7.50 Mean = 9.55 IRR = 0.86 Not available Not statistically significant, p ≥ 0.05

footnote59

Submitted by user on Fri, 03/15/2019 - 14:29

Incidence rate ratio is calculated using imputed data and adjusted for baseline covariates.

High Maternal victimization (CTS)
FavorableUnfavorable or ambiguousNo Effect
Full sample, Hawaii trial Average when child was 7-9 years old 640 mothers Mean = 3.35 Mean = 4.01 IRR = 0.95 Not available Not statistically significant, p ≥ 0.05

Outcome measure summary

Reductions in juvenile delinquency, family violence, and crime
Outcome measure Description of measure Data collection method Properties of measure

CTS: Maternal perpetration

The CTS assesses victimization and perpetration related to intimate partner violence and maltreatment. The researchers used the 38-item CTS1 at baseline and the 78-item revised CTS2 at subsequent follow-ups. The CTS2 includes questions on verbal aggression/abuse, physical assault, sexual coercion/abuse, and injury. The researchers transformed the CTS’s categorical response categories into counts: never (0), once (1), twice (2), 3 to 5 times (4), 6 to 10 times (8), 11 to 20 times (15), and more than 20 times (25). Parent/caregiver report

Cronbach’s α: verbal aggression and abuse (.79), physical assault (.86), sexual coercion and abuse (.87), and injury (.95),

CTS: Maternal victimization

The CTS assesses victimization and perpetration related to intimate partner violence and maltreatment. The researchers used the 38-item CTS1 at baseline and the 78-item revised CTS2 at subsequent follow-ups. The CTS2 includes questions on verbal aggression/abuse, physical assault, sexual coercion/abuse, and injury. The researchers transformed the CTS’s categorical response categories into counts: never (0), once (1), twice (2), 3 to 5 times (4), 6 to 10 times (8), 11 to 20 times (15), and more than 20 times (25). Parent/caregiver report

Cronbach’s α: verbal aggression and abuse (.79), physical assault (.86), sexual coercion and abuse (.87), and injury (.95),